Lake and Sumter Style Magazine
5:10 pm EDT
Monday, July 26, 2021

Matter of life and breath

For the sake of your health, don’t sleep on sleep apnea.

Kathy Chastain learned that bad dreams sometimes do come true.

Not long ago, the Eustis resident would dream about suffocating, then she’d abruptly wake up choking or gasping for air. 

“It was like my body was talking to me in my dreams and telling me I was not breathing,” she says.  

Kathy suffered from sleep apnea, a condition that causes breathing to stop or become very shallow during sleep. During her worst spells, she awoke in the morning feeling exhausted, her mind cloudy, her body deprived of true rest. The condition disrupted a good night’s sleep and a hard day’s work.

“It was particularly hard in the morning to get dressed and get ready for work,” says Kathy, an OB/GYN educator at AdventHealth Waterman. “I was tired all the time during the day.”

Dr. Rosemary Cirelli in a private sleep lab room where patients can relax during a sleep study test. // Photo: Nicole Hamel

Sleep apnea affects an estimated 22 million Americans, according to the American Sleep Apnea Association. While people of all ages are diagnosed with sleep apnea, the typical patient is an obese male in his 50s or 60s with a neck size of 17 inches or greater. Common symptoms include snoring, waking up with dry mouth, excessive daytime sleepiness and abrupt awakenings accompanied by gasping or choking. Patients can experience pauses in breathing that last up to 30 seconds and occur 20 to 30 times per hour, impeding restful sleep. 

But adverse health effects go well beyond morning grogginess and daytime drowsiness. Studies show that sleep apnea causes other medical conditions such as diabetes, high blood pressure, arrhythmia, strokes and heart attacks. 

Dr. Rosemary Cirelli, a pulmonologist and sleep medicine specialist at AdventHealth Medical Group Pulmonary and Sleep Medicine in Tavares, has observed dire consequences of untreated sleep apnea in patients she’s treated since the mid-1990s. 

“Patients are three to five times more likely to suffer a stroke, heart attack, sudden cardiac death, and develop cardiac rhythm disturbances,” she says. “Over time there are higher incidences of diabetes because low oxygen levels that occur at night causes glucose intolerance and insulin resistance. Also, sleep apnea can lead to higher incidences of dementia because the glymphatic system in the brain doesn’t clear toxins and metabolites that build up during the day if you’re not getting good sleep.”

Atrial fibrillation, a heart rhythm abnormality in which the heart experiences mechanical and chemical changes when a person is suddenly awakened by lack of oxygen night after night, is one of the most common conditions associated with sleep apnea. Research conducted by Harvard Medical School estimates that as many as 53 percent of people with atrial fibrillation also have sleep apnea. 

A sleep study test can determine whether a patient has sleep apnea. // Photo: Nicole Hamel

Electrocardiologists treat atrial fibrillation by shocking the heart to convert it from irregular rhythm back into a normal rhythm. However, shocking the heart typically proves ineffective in patients who also have untreated sleep apnea. 

 “When the doctor shocks the heart back into rhythm, it will only last 20 percent of the time if nothing is done to address sleep apnea,” Dr. Cirelli says. “However, if a doctor also treats sleep apnea, then the success rate improves to 80 percent. It is important for anyone with atrial fibrillation to have a sleep study to be able to confirm or rule out sleep apnea.”

Sleep apnea also puts stress on the cardiovascular system. Approximately 70 percent of people admitted to the hospital for coronary artery disease also had sleep apnea, according to the American Thoracic Society. In addition, a study presented at the Radiological Society of North America’s 2020 meeting revealed that sleep apnea patients have a larger amount of plaque build-up in their coronary arteries. 

“When the airway is blocked off and your oxygen levels drop, your body responds to that with narrowing of blood vessels,” Dr. Cirelli said. “That makes it easier for plaque to build up in the arteries.”

The outlook is equally bleak for chronic pain patients who also have sleep apnea. With sleep deprivation, the body does not release endorphins, which are natural pain killers. Thus, a patient’s pain threshold is lowered. 

Sleep apnea also affects memory, cognition and mood. 

“Patients tell me they feel like they’re in a fog and not thinking clearly,” Dr. Cirelli says. “They’re having trouble remembering things and their executive decision-making capabilities are impaired. They’re irritable and grouchy and don’t enjoy doing certain activities they used to love.”

Steps to treatment

Nine years ago, life became a constant brain fog for Char Benedict of Grand Island. Each morning, she woke up with painful headaches and felt disoriented. As a deployment analyst with Blue Cross Blue Shield, she struggled to stay awake during company meetings. 

“I wasn’t getting any REM sleep and felt like a non-functioning person,” she says. 

At the urging of her doctor, Char agreed to undergo a sleep study. The sleep study area resembled a comfortable hotel room, allowing her to watch television, read books and relax. The biggest difference was trying to fall asleep with multiple wires attached to her body. Doctors recorded her brain waves, heartbeats and breathing while she slept, as well as limb movements and oxygen in her blood. 

The study revealed that Char was experiencing between 24 and 36 apneas each hour, causing significant decreases in airflow. 

Her doctor prescribed a continuous positive airway pressure (CPAP) machine. While she is sleeping, Char wears a mask that is connected to the machine’s motor by a hose, keeping her airway open and allowing for normal nighttime breathing. Getting used to wearing a mask that delivers pressurized air during sleep took some time. She also was on the receiving end of harmless heckling from her husband Dan. 

“I would laugh at her with the mask on,” says Dan, a self-admitted jokester. “It looked like a diving mask, so I’d ask her how deep she was planning on diving.”

These days, Dan is more sympathetic. He was diagnosed with sleep apnea seven months ago and now uses a CPAP, too. Both admit the life-changing benefits are evident and undeniable. 

“For me, it was like being wide awake for the first time in years,” Char says. “I experienced a total turnaround and got my life back.”

Dan Benedict // Photo: Nicole Hamel

Dan wakes up each morning at 7:30 a.m. and walks four miles.  “I have better mental clarity and wake up feeling refreshed,” he says.  

Kathy Chastain, the sleep apnea patient from Eustis, has experienced similar results since receiving treatment. While wearing a CPAP leaves some patients feeling embarrassed, she maintains a different outlook. 

“I’m embarrassed not to wear it,” she says. “I used to snore so loud that my husband would get up in the middle of the night and go to another bedroom. So having a CPAP machine is less embarrassing as far as snoring. It also improves fatigue, sleep and mental clarity, and to me, those things far outweigh any feelings of embarrassment.”

Dr. Cirelli echoed those sentiments and cautions patients to ignore the stigma associated with CPAP machines. 

“There are a lot of misconceptions about CPAP. They say the mask is not attractive. However, it’s less attractive to disrupt your bed partner’s sleep during the night because you’re snoring, you’re gasping, and they have to nudge you to breathe again. The new machines make absolutely no noise. They run so quietly that you can’t even tell they’re on.” 

Other sleep apnea treatments exist. In cases of mild sleep apnea, doctors may use positional therapy because patients experience less airway obstruction when sleeping on their sides. Some patients receive positive results by using a mandibular advancement appliance, which positions the lower jaw forward and increases the size of the upper airway. Patients with enlarged tonsils that contribute to airway restriction can have them surgically removed.   

For sleep apnea sufferers who face dire health consequences without medical intervention, having several treatment modalities available is a breath of fresh air.

“If you have cancer, you go to a doctor,” Dan says. “Why wouldn’t you go to a doctor if you have sleep apnea, especially if it can do a great deal of harm to your body other than just feeling tired?”

Celebrities living with sleep apnea

• Comedians Rosie O’Donnell and Roseanne Barr

• Mythbusters personality Adam Savage

• Former Texas Governor Rick Perry

• Former NBA player Shaquille O’Neal

• NFL quarterback Brett Favre

• NFL quarterback JaMarcus Russell 

• Star Trek icon William Shatner

• Comedian and magician Penn Jillette

• Author Anne Rice

• Daniel Lawrence Whitney (Larry the Cable Guy)

• Musical legend Quincy Jones

Source: American Sleep Apnea Association